Canal Block Research Articles

Efficacy of single-shot adductor canal block before Versus after primary total knee arthroplasty - Does timing make a difference? A randomized controlled trial.

Total knee arthroplasty (TKA) is associated with severe postoperative pain. Multimodal analgesia, including peripheral nerve block, is recommended for post-operative pain relief. Administration of some pain medications prior to surgery has shown to be more effective than after the operation. This is a prospective, randomized controlled trial designed to compare the analgesic efficacy of the adductor canal block (ACB) performed immediately before or immediately after primary total knee arthroplasty (TKA). We hypothesized that ACB before the surgery will reduce postoperative pain and improve knee function. A total of 50 patients were enrolled and randomized into 2 groups, with 26 patients receiving a preoperative ACB and 24 receiving a postoperative ACB. Treatment groups were similar in terms of gender (p = .83), age (p = 0.61) weight (p = .39) and ASA score. Average visual analogue scale (VAS) on arrival to the post-anesthesia care unit (PACU) were 4.9 ± 3.2 in the preoperative ACB versus 3.4 ± 2.8 for the postoperative ACB (p = .075). VAS scores at different time points as well as the mean, minimal and maximal reported VAS scores were not significantly different between the two groups. The cumulative quantities of Fentanyl administered by the anesthesia team was comparable between the groups. Similarly, the dosage of Morphine, Tramadol, Acetaminophen and Dipyrone showed only small variations. The Quality of Recovery Score, Knee Society Scores and knee range of motion did not differ between the groups. Our findings demonstrate no significant differences in patient total narcotics consumption, pain scores and functional scores, between preoperative and postoperative ACB in patients undergoing TKA. The trial was registered at www.clinicaltrials.gov and was assigned the registration number NCT02908711. level I randomized controlled trial.

Adductor canal block versus femoral nerve block for pain control after total knee arthroplasty: A systematic review and Meta-analysis.

Background:Femoral nerve block is a widely accepted nerve block method with evident reduction in consumption of opioid painkiller and minimization of the duration of hospital stay but may cause weakness of quadriceps muscle strength. Adductor canal block is another nerve block technique that attracts the attention of scientific community nowadays because of its possible superiority over Femoral nerve block regarding mobility and muscle strength.Methods:This is a systematic review and meta-analysis of 33 studies, aiming to compare femoral nerve block with adductor canal block following total knee arthroplasty regarding pain control and mobilization.Results:Adductor canal block showed better preservation of quadriceps muscle strength (MD = 0.28, 95% CI [0.11, 0.46], P = .002), and better mobilization up to 2 days postoperatively. However, no significant difference was found between the 2 interventions regarding pain control (MD = 0.06, 95% CI [−0.06, 0.17], P = .33) or opioid consumption (SMD = 0.08, 95% CI [−0.06, 0.22], P = .28) up to 2 days postoperatively. The better mobilization results of adductor canal block did not translate into a significant difference in the risk of falls or patients’ satisfaction; however, adductor canal block patients had less mean length of hospital stay than the patients with femoral nerve block.Conclusion:Both femoral nerve block and adductor canal block provide similar results regarding pain control and opioid consumption, however adductor canal block provides better preservation of quadriceps strength and mobilization, giving it more advantage over femoral nerve block.

A Randomized Controlled Pilot Study Using Ultrasound-Guided Percutaneous Cryoneurolysis of the Infrapatellar Branch of the Saphenous Nerve for Analgesia Following Total Knee Arthroplasty.

Total knee arthroplasty (TKA) is frequently associated with severe, prolonged postsurgical pain, and therefore local anesthetic-based peripheral nerve blocks are commonly used for postoperative analgesia. Cryoneurolysis involves the use of freezing temperatures to provide a reversible sensory (and motor) block with a duration measured in weeks and months, more commensurate with the typical period of post-TKA pain. We therefore conducted a randomized controlled pilot study to evaluate the use of this modality for the treatment of pain following TKA to (1) determine the feasibility of and optimize the study protocol for a subsequent definitive clinical trial; and (2) estimate analgesia and opioid reduction within the first 3 postoperative weeks. A convenience sample of 16 patients undergoing primary TKA with a single-injection and/or continuous adductor canal nerve block were randomized to receive either active cryoneurolysis or a sham procedure targeting the infrapatellar branch of the saphenous nerve, in a participant-masked fashion. This was a pilot study with a relatively small number of participants, and therefore resulting data were not analyzed statistically. Compared with participants receiving sham, the active treatment group reported slightly lower average and worst pain scores as well as opioid consumption and sleep disturbances due to pain at a majority of postoperative time points between postoperative days (POD) 4-21. Preoperative ultrasound-guided cryoneurolysis of the infrapatellar branch of the saphenous nerve is feasible and may provide analgesic benefits for multiple weeks following TKA. A definitive randomized controlled trial appears warranted.

Single shot adductor canal block combined with intravenous patient-controlled analgesia can be effective as continuous adductor canal block in reducing opioid consumption and breakthrough pain after total knee arthroplasty

PurposeThe aim of this study was to compare the following three analgesic methods after Total knee arthroplasty (TKA): intravenous patient-controlled analgesia (IV-PCA), continuous adductor canal block (C-ACB), and intravenous patient-controlled analgesia combined with single shot adductor canal block (PCA + sACB).MethodsRecords of 482 patients undergoing primary TKA from September 2019 to September 2020 were analyzed. Patients were divided into three pain control groups: IV-PCA (n = 180), C-ACB (n = 173) and PCA + sACB (n = 129). Single shot adductor canal block was performed 24 h after surgery in the PCA + sACB group. Rescue opioid consumption, breakthrough pain, pain numerical rating scale (NRS), and anti-emetics administration were measured from postoperative day (POD) 1 to POD 5.ResultsRescue opioid consumption was less in C-ACB or PCA + sACB group than in the IV-PCA group at POD1 (p < 0.001 and p = 0.002, respectively). Patients in C-ACB and PCA + sACB groups had less breakthrough pain (NRS > 5) than the IV-PCA group at POD1 (p = 0.007). On POD2, C-ACB was statistically superior to IV-PCA (p = 0.011) in terms of breakthrough pain. Postoperative pain NRS was lower in the C-ACB and PCA + sACB groups than in the IV-PCA group (p = 0.025 and p = 0.019, respectively). The total number of anti-emetics consumption was lower in C-ACB and PCA + sACB groups than in the IV-PCA group (p = 0.003 and p = 0.002, respectively).ConclusionPCA + sACB not only reduced patients’ need for rescue opioids, but also decreased the number of breakthrough pain and anti-emetics compared to IV-PCA in early postoperative days after TKA. However, C-ACB and PCA + sACB did not differ significantly in analgesic efficacy or opioid-related side effects. PCA + sACB can be as effective as C-ACB for patients undergoing TKA.Level of evidenceRetrospective cohort study, level III.

335 Motor Sparing Peripheral Nerve Block: A Modern Approach to Total Knee Arthroplasty

Abstract Aim To maximise postoperative analgesia, whilst minimising opioid use, motor sparing peripheral nerve blocks have been described as an alternative to local infiltration analgesia (LIA) with adductor canal block (ACB) in total knee arthroplasty (TKA). At The Robert Jones and Agnes Hunt Orthopaedic Hospital, we have developed a new technique, involving ten separate injections to the four genicular nerves, saphenous nerve, nerve to the vastus medialis, the popliteal plexus and to the medial, intermediate, and lateral cutaneous nerves of the thigh. The aim was to compare the analgesic effect of this type of motor sparing nerve block against LIA with ACB in TKA. Method Two groups were identified retrospectively. The test group included fifty patients who received 5ml each of 0.75% Levobupivacaine to the saphenous nerve and nerve to the vastus medialis, and 40ml of 0.25% Levobupivacaine to the four genicular nerves, the popliteal plexus, and to the cutaneous nerves. A matched control group received standard treatment with ACB and LIA. The primary outcome was the consumption of opioid analgesics, measured as a total morphine equivalent. Results For patients in the test group, the mean amount of IV morphine equivalent administered in the first 48-hours postoperatively was 34mg vs 108mg. This equates to a 68% reduction in opioid consumption compared to the control group. Conclusions Motor sparing nerve blocks provide a significant reduction in opioid consumption compared to LIA with ACB in TKA. The results have implications in terms of pain management, reduced opioid-induced side effects and overall, enhanced patient recovery.

Fracture Resistance of Heat-Treated Nickel-Titanium Rotary Files After Usage and Autoclave Sterilization: An In Vitro Study

IntroductionThis study aimed to evaluate the dynamic cyclic fatigue resistance of heat-treated nickel-titanium (NiTi) files after usage and autoclaving. MethodsTwo heat-treated NiTi file systems with tip sizes of #25 (ie, ProTaper Gold F2 [Dentsply Sirona, Charlotte, NC] and TruNatomy Prime [Dentsply Sirona]) were selected. Files of each system were divided into 3 experimental subgroups (n = 10). For subgroup 1, new files were tested to establish the baseline number of cycles to failure (NCF). For subgroup 2, files underwent canal instrumentation in a simulated J-shaped canal block with 35° of curvature and a 16.5-mm length. The simulated canals were pre-enlarged using stainless steel files #10K and #15K. After instrumentation, the files were tested. For subgroup 3, files underwent canal instrumentation as in subgroup 2 followed by autoclave sterilization and then were tested for cyclic failure. The cyclic fatigue test was performed in dynamic pecking motion under body temperature. The time to fracture was recorded and calculated into NCF. Fracture fragment lengths were measured using a digital microcaliper. Statistical analysis was conducted using the independent t test and multifactorial analysis of variance with 95% significance. Scanning electron microscopy was used to examine the topographic characteristics after cyclic fatigue tests. ResultsThere were no significant differences between file systems in subgroup 1 using new files (P < .05). Although PG reduced the NCF after use, TN showed a significantly increased NCF (P < .05). However, after sterilization, TN showed a reduced NCF compared with the used one (P < .05). ConclusionsCyclic loading by usage and heat treatment during sterilization may result in different cyclic fatigue resistance according to the geometry and alloy characteristics.

Effect of introduction of routine single shot adductor canal block in primary total knee arthroplasty in a rural Australian setting.

There is a growing demand for quality osteoarthritis management available in Australia. There has been increasing emphasis on post-total knee replacement pain relief as a significant issue, especially in the context of postoperative recovery protocols which focus on early mobility. The aim of this study was to assess if the addition of adductor canal blocks (ACB) reduced postoperative pain and affected mobility post primary total knee arthroplasty (TKR) at Armidale Rural Referral Hospital (ARRH). A retrospective cohort study was performed of unilateral TKR patients before and after the addition of adductor canal blocks to the TKR protocol at ARRH. Forty-seven patients were included in the study who are matched for age and radiographic disease severity. All patients were prescribed post-operative analgesia per the protocol. Patients who received an ACB had a significant difference in opioid consumption in the first 24 h post-operative compared with those who did not, 115.90 mg oral morphine compared to 66.07 mg (P= 0.0001). This was also supported by a significant difference in patient self-rated numerical pain score between groups, no ACB group 3.09/10 and ACB group 1.05/10 (P= 0.0001). The ACB group were able to mobilize further on post-op days 1 and 2 than those who did not receive an ACB with the ACB group (P= 0.0001 and 0.0008). This adds to the evidence supporting the use of Adductor Canal Blocks in patients undergoing total knee arthroplasty, of especial significance in a rural population.

Significantly earlier ambulation and reduced risk of near-falls with continuous infusion nerve blocks: a retrospective pilot study of adductor canal block compared to femoral nerve block in total knee arthroplasty

BackgroundNear-falls should be detected to prevent falls related to the earlier ambulation after Total knee arthroplasty (TKA). The quadriceps weakness with femoral nerve block (FNB) has led to a focus on adductor canal block (ACB). We purposed to examine the risk of falls and the earlier ambulation in each continuous infusion nerve block.MethodsContinuous infusion nerve block (FNB or ACB) was performed until postoperative day (POD) 2 or 3. Pain levels and falls/near-falls with knee-buckling were monitored from POD 1 to POD 3. The score on the manual muscle test, MMT (0 to 5, 5 being normal), of the patients who could ambulate on POD 1, was investigated.ResultsA total of 73 TKA cases, 36 FNB and 37 ACB, met the inclusion criteria. No falls were noted. But episodes of near-falls with knee-buckling were witnessed in 14 (39%) cases in the FNB group and in 4 (11%) in the ACB group (p = 0.0068). In the ACB group, 81.1% of patients could ambulate with parallel bars on POD 1, while only 44.4% of FNB patients could do so (p = 0.0019). The quadriceps MMT values in the ACB group was 2.82, significantly higher than 1.97 in the FNB group (p = 0.0035). There were no significant differences in pain as measured with a numerical rating scale (NRS) and rescue analgesia through POD 3.ConclusionACB was associated with significantly less knee-buckling and earlier ambulation post-TKA, with better quadriceps strength. Our study indicated the incidence of falls and near-falls with continuous infusion nerve blocks, and support the use of ACB to reduce the risk of falls after TKA. It is suggested that a certain number of the patients even with continuous ACB infusion should be considered with the effect of motor branch to prevent falls.

Evaluation of Analgesic Efficacy of Ultrasound-Guided Adductor Canal Block With 20 mL of 0.5% Ropivacaine in Patients Undergoing Knee Surgeries-A Randomized Control Trial.

Adductor canal block (ACB) is a motor sparing block providing analgesia for surgeries involving anterior part of the knee. The aim of our study was to evaluate the analgesic efficacy of ACB to reduce pain in arthroscopic knee surgeries done under spinal anesthesia. Our primary objective was to evaluate the 24 hours postoperative morphine consumption. The secondary objectives were to evaluate the visual analog scale (VAS) scores at rest and during knee flexion, hemodynamics and side effects of the block. In this prospective randomised controlled trial, 70 patients who underwent arthroscopic knee surgeries were randomly divided into two groups, A and C. Surgeries were done under spinal anesthesia. Group A patients received ACB with 20 mL of 0.5 % ropivacaine using ultrasound postoperatively. Block was not performed in group C. The amount of morphine consumption in PCA pump, duration of analgesia, mean VAS scores at rest and flexion, hemodynamics and adverse effects were monitored. The average morphine consumption was significantly lesser with a P-value ＜ 0.001 in group A (8.628 ± 2.001 mg) when compared to group C (21.914 ± 5.118 mg). The duration of analgesia was longer in group A (365.71 ± 53.648 min vs. 150.429 ± 22.537 min) with highly significant P-value of ＜ 0.001. Group A patients had significantly decreased VAS scores at rest and knee flexion and better haemodynamic stability. We conclude that ultrasound-guided ACB resulted in significantly lesser morphine consumption after arthroscopic knee surgeries. ACB prolonged the duration of analgesia with better hemodynamics, lesser VAS pain scores and with no complications.

Review on Nerve Blocks Utilized for Perioperative Total Knee Arthroplasty Analgesia.

Total Knee Arthroplasty (TKA) is an increasingly common procedure performed for advanced osteoarthritis. Optimal perioperative pain management strategies are critical for early mobilization and shorter hospital stays in TKA. Peripheral nerve blocks commonly used in TKA perioperative analgesia including individual and combined femoral, obturator, sciatic, lumbar plexus, and adductor canal nerve blocks. Overall, the safety profile varies depending on which block is utilized, but the current evidence suggests when optimally chosen and delivered, peripheral nerve blocks may provide a safe, effective option for perioperative analgesia. Determining optimal analgesic regimens for total knee arthroplasty is critical to improve postoperative pain, patient satisfaction, decreasing opioid usage, recovery times and functional outcomes, and as such, peripheral nerve blocks may represent a viable option to supplement analgesic requirements in the perioperative period.

Adductor Canal Block (ACB) provides Adequate Postoperative Analgesia in Patients Undergoing Total Knee Arthroplasty (TKA): Case Report

Background: Effective postoperative multimodal analgesia facilitates early physical rehabilitation to maximize the postoperative range of motion and prevent joint adhesions following total knee arthroplasty (TKA). Adductor canal block has been reported as a supplement to multimodal analgesia protocols in patients undergoing TKA. The use of ultrasound (US) guidance has improved the success rates of the blocks compared with blind approaches. Case Presentation: This report described two elderly patients undergoing TKA with ACB as postoperative pain management, resulting in adequate pain control during the postoperative period. Conclusion: Adductor canal block can be used to optimize multimodal analgesia by reducing opioid requirements and enhancing recovery after TKA.

Perineural Methylprednisolone Depot Formulation Decreases Opioid Consumption After Total Knee Arthroplasty.

PurposeOpioid consumption after total knee arthroplasty (TKA) remains a challenge with single injection nerve blocks even with common local anesthetic adjuvants dexamethasone (DEX). This study aimed to investigate the effects of adding methylprednisolone acetate (MPA) to adductor canal blocks (ACB) and interspace between the popliteal artery and capsule of the posterior knee (iPACK) blocks on postoperative opioid consumption.MethodsA retrospective analysis was conducted on 100 consecutive TKA patients equally assigned into two groups, with one group receiving DEX through ACB and iPACK block and the other group receiving DEX and methylprednisolone acetate (DEX/MPA) through the same nerve blocks. The primary outcome was cumulative opioid consumption (oral milligram morphine equivalent, OME) during hospitalization for up to three days. Secondary outcomes included daily opioid consumption, highest rest and active pain scores, prosthetic knee joint active range of motion (AROM), laboratory studies including fasting serum glucose (FSG) and white blood cell count (WBC) on each postoperative day (POD), and length of hospital stay.ResultsCumulative opioid consumption was significantly lower in the DEX/MPA group vs DEX group (median difference (95% CI) = −45.3 (−80.5 to −10), P = 0.011). The highest rest and active pain scores were both significantly lower in the DEX/MPA group than in DEX group on POD 2 (least square mean difference (95% CI) = −1.3 (−2.3 to −0.4), P = 0.005 and −0.9 (−1.8 to −0.1), P = 0.031, respectively). Except on POD 1, FSG values were significantly lower in the DEX/MPA group (median difference (95% CI) = −22.5 (−36 to −8.9), P = 0.001). AROM, WBC, and length of stay were comparable between both groups.ConclusionCompared to perineural DEX alone, the addition of MPA further decreases postoperative opioid consumption without clinically significant changes on FSG and WBC.Level of EvidenceIII.

No Benefits of Adding Dexmedetomidine, Ketamine, Dexamethasone, and Nerve Blocks to an Established Multimodal Analgesic Regimen after Total Knee Arthroplasty.

An optimal opioid-sparing multimodal analgesic regimen to treat severe pain can enhance recovery after total knee arthroplasty. The hypothesis was that adding five recently described intravenous and regional interventions to multimodal analgesic regimen can further reduce opioid consumption. In a double-blinded fashion, 78 patients undergoing elective total knee arthroplasty were randomized to either (1) a control group (n = 39) that received spinal anesthesia with intrathecal morphine, periarticular local anesthesia infiltration, intravenous dexamethasone, and a single injection adductor canal block or (2) a study group (n = 39) that received the same set of analgesic treatments plus five additional interventions: local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intraoperative intravenous dexmedetomidine and ketamine, and postoperatively, one additional intravenous dexamethasone bolus and two additional adductor canal block injections. The primary outcome measure was 24-h cumulative opioid consumption after surgery and secondary outcomes were other analgesics, patient recovery, functional outcomes, and adverse events. Opioid consumption was not different between groups at 24 h (oral morphine equivalents, mean ± SD; study: 23.7 ± 18.0 mg vs. control: 29.3 ± 18.7 mg; mean difference [95% CI], -5.6 mg [-2.7 to 13.9]; P = 0.189) and all other time points after surgery. There were no major differences in pain scores, quality of recovery, or time to reach rehabilitation milestones. Hypotensive episodes occurred more frequently in the study group (25 of 39 [64.1%] vs. 13 of 39 [33.3%]; P = 0.010). In the presence of periarticular local anesthesia infiltration, intrathecal morphine, single-shot adductor canal block and dexamethasone, the addition of five analgesic interventions-local anesthetic infiltration between the popliteal artery and capsule of the posterior knee, intravenous dexmedetomidine, intravenous ketamine, an additional intravenous dexamethasone dose, and repeated adductor canal block injections-failed to further reduce opioid consumption or pain scores or to improve functional outcomes after total knee arthroplasty.

Pain management after total knee arthroplasty: PROcedure SPEcific Postoperative Pain ManagemenT recommendations.

The PROSPECT (PROcedure SPEcific Postoperative Pain ManagemenT) Working Group is a global collaboration of surgeons and anaesthesiologists formulating procedure-specific recommendations for pain management after common operations. Total knee arthroplasty (TKA) is associated with significant postoperative pain that is difficult to treat. Nevertheless, pain control is essential for rehabilitation and to enhance recovery. To evaluate the available literature and develop recommendations for optimal pain management after unilateral primary TKA. A narrative review based on published systematic reviews, using modified PROSPECT methodology. A literature search was performed in EMBASE, MEDLINE, PubMed and Cochrane Databases, between January 2014 and December 2020, for systematic reviews and meta-analyses evaluating analgesic interventions for pain management in patients undergoing TKA. Each randomised controlled trial (RCT) included in the selected systematic reviews was critically evaluated and included only if met the PROSPECT requirements. Included studies were evaluated for clinically relevant differences in pain scores, use of nonopioid analgesics, such as paracetamol and nonsteroidal anti-inflammatory drugs and current clinical relevance. A total of 151 systematic reviews were analysed, 106 RCTs met PROSPECT criteria. Paracetamol and nonsteroidal anti-inflammatory or cyclo-oxygenase-2-specific inhibitors are recommended. This should be combined with a single shot adductor canal block and peri-articular local infiltration analgesia together with a single intra-operative dose of intravenous dexamethasone. Intrathecal morphine (100 μg) may be considered in hospitalised patients only in rare situations when both adductor canal block and local infiltration analgesia are not possible. Opioids should be reserved as rescue analgesics in the postoperative period. Analgesic interventions that could not be recommended were also identified. The present review identified an optimal analgesic regimen for unilateral primary TKA. Future studies to evaluate enhanced recovery programs and specific challenging patient groups are needed.

Impact of varying degrees of peripheral nerve blockade on experimental pressure and ischemic pain: adductor canal and sciatic nerve blocks in a human model of compartment syndrome pain

IntroductionEarly diagnosis of acute extremity compartment syndrome is crucial to timely surgical management. Pain is commonly used as an early diagnostic sign for acute extremity compartment syndrome, making regional anesthesia...

Pendampingan Kepada Masyarakat Tentang Manajemen Pengelolaan Gambut (Histosol: Level Hemic) Desa Keub Kecamatan Arongan Lambalek Kabupaten Aceh Barat Provinsi Aceh

This assistance is expected to provide additional information about peat soil management to the people of Keub Village, Arongan Lambalek District, West Aceh Regency, Aceh Province. Farmers can independently manage any problems that arise on peat soils, so they are able to take the right steps in current and future management efforts so that the land can produce optimally. Its management includes physical (mechanical), chemical, and biological aspects. Utilization of peat based on improving the community's economy and preserving the ecology of peat requires careful and measured preparation, including; the construction of integrated canal blocks by carrying out control and evaluation through strengthening institutional capacity including communities around peat (practitioners) and academics in a holistic manner in a definitive manner, with the hope that the use of peatlands will not have a negative impact on the current and future environment.&#x0D;

Poster 245: Periarticular Local Infiltrative Anesthesia after Anterior Cruciate Ligament Reconstruction: A Comparison to Regional Adductor Canal Block with Matched Sub-Analysis

Objectives:There is a paucity of literature that directly compares postoperative pain control and hospital recovery after using periarticular local infiltrative anesthesia (LIA) or regional anesthesia with an adductor canal block (ACB) for ambulatory anterior cruciate ligament reconstruction (ACLR) surgery. Additional studies are needed to investigate the analgesic efficacy of both ACB and LIA in patients undergoing ACLR surgery with concomitant procedures. The purpose of this study is to compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA).Methods:Study Design: Retrospective comparison studyA retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups matched for age, sex, BMI, graft type, and meniscal treatment. A p-value < 0.05 indicated statistical significance.Results:There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 ± 1.5 vs. ACB 2.4 ± 1.4, p=0.334) and total MMEs were similar (LIA 17.6 ± 7.6 vs. ACB 18.5 ± 6.7 (MME), p=0.134). Total time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 ± 1.4 vs ACB: 2.7 ± 1.5, p=0.122) or total MMEs (LIA 18.6 ± 6.7 vs. ACB 17.9 ± 7.1, p=0.532).Conclusions:The use of ACB or LIA resulted in similar pain levels and opioid consumption during early recovery after ACLR surgery.

Effect of Ropivacaine Combined with Small Doses of Triamcinolone and Continuous Nerve Block of Unilateral Paravertebral Canal Guided by Ultrasound on Metastasis after Radical Treatment of Lung Cancer

Continuous nerve block of unilateral paravertebral canal is one of the most reliable and the most commonly performed techniques to control intra- and postoperative pain. It is the technique of injecting local anaesthetic alongside the thoracic vertebra close to where the spinal nerves emerge from the intervertebral foramen. This produces unilateral, segmental, somatic, and sympathetic nerve blockade, which is effective for anaesthesia and in treating acute and chronic pain of unilateral origin from the chest and abdomen. Ultrasound guidance with or without nerve stimulator has reduced the amount of local anaesthetics (LA) to achieve a successful block, which may minimize complications of continuous nerve block of unilateral paravertebral canal. Previous studies have suggested that continuous nerve block of unilateral paravertebral canal with ropivacaine combined with small doses of triamcinolone was effective to achieve sensory and motor block after lung cancer surgery. Previous studies have used a fixed large dose in different volumes and concentrations for a nerve block, infraclavicular block, axillary block, and humeral canal block. The results of these studies with the respects of onset time, successful rate, and block duration were not consistent. Various factors, including the technique used, the anatomic aspects of the injection, and the pharmacodynamics aspect of drug, may influence the results. We tested the hypothesis that 50,25,10 mg ropivacaine and 50,25,10 mg triamcinolone of three combinations of volumes and concentrations for ultrasound-guided continuous nerve block of unilateral paravertebral canal produce different effects in the aspect of survival rate. Here, the drug effect was analyzed using the cross cluster K-nearest neighbors (KNN). The whole experimentation was carried out under MATLAB environment.

Comparison of adductor canal block and femoral nerve block for pain management in anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials.

Objective:To compare the efficacy of adductor canal block and femoral nerve block for pain management in patients with anterior cruciate ligament reconstruction.Methods:A computerized search was performed in the database of PubMed, Embase, Web of Science and Cochrane Library for randomized controlled trials. The outcome measures included visual analog scale, morphine consumption, quadriceps strength, length of hospitalization and postoperative adverse events. The risk of bias of randomized controlled trials was assessed according to the Cochrane Risk of Bias Tool. All quantitative syntheses were completed using STATA version 14.Results:Seven randomized controlled trials involving a total of 643 patients were included in our meta-analysis. The present meta-analysis indicated that there were no significant differences between the 2 groups in terms of postoperative pain score, opioid consumption, length of hospitalization or adverse effects after anterior cruciate ligament reconstruction. However, adductor canal block showed superior quadriceps strength and range of motion in the early postoperative period.Conclusion:Adductor canal block shows similar and adequate analgesia compared to the femoral nerve block in anterior cruciate ligament reconstruction and adductor canal block can preserve a higher quadriceps strength and better range of motion.

Effectiveness of ERAS (Enhanced Recovery after Surgery) Protocol via Peripheral Nerve Block for Total Knee Arthroplasty.

Peripheral nerve block (PNB) for patients with total knee arthroplasty (TKA) is one of the recommended interventions in ERAS protocols. However, most existing studies involved unilateral TKA (UTKA). As such, this study aimed to evaluate the effectiveness of PNB in terms of immediate postoperative analgesia, length of hospital stays (LOS), and early functional outcomes in both UTKA and simultaneous bilateral TKAs (BTKAs). We reviewed 236 patients who underwent primary TKA with PNB, with 138 and 98 being UTKA and BTKAs, respectively; those in the PNB group underwent femoral nerve and adductor canal block. The matched control and PNB groups—who received intravenous/epidural patient-controlled analgesia (IVPCA/PCEA) alone or IVPCA in addition to PNB after surgery, respectively—were compared. The VAS scores at rest until 48 h after surgery were significantly lower in PNB groups compared to those in the IVPCA groups. At 0– 6 h of activity, VAS scores of the UTKA with PNB group were also lower than the IVPCA group. Compared to PCEA groups, VAS scores at 0–6 h of activity were higher in both the UTKA and BTKAs with PNB groups. However, at 24–48 h at rest, the scores of those in the UTKA with PNB group were lower than those in the PCEA group. The control and experimental UTKA and BTKAs groups had similar LOS and functional outcomes at 90 days postoperatively. In primary TKA, PNB has great analgesic effects for immediate postoperative pain control, and represents a similar analgesic effect to epidural PCA.